title: A brief retrospective review of medical records comparing outcomes for inpatients treated via telehealth versus in-person protocols: is telehealth equally effective as in-person visits for treating neutropenic fever, bacterial pneumonia, and infected bacterial wounds?
abstract: The incidence of infectious diseases in the United States has been increasing since 1980. Re-emergent conditions, multidrug-resistant bacteria, newly identified infections, and bioterrorism have prompted public health surveillance and control initiatives, including the use of telehealth technology. Infectious diseases, such as West Nile Virus, pose a particular threat to rural areas, where access to infectious disease specialists (IDS) is limited. Initial, in-patient IDS consultations are reimbursed by Centers for Medicare & Medicaid Services for in-person and for telehealth services. Follow-up consultation and subsequent care visits are reimbursed when delivered via in-person care, but not reimbursed when delivered via telehealth. The purpose of this study is to investigate the efficacy of telehealth technology (interactive videoconferencing) in providing timely, efficient, and prudent infectious disease care for rural patients. We conducted a retrospective, comparative review of medical records (n = 107) from inpatients at a metropolitan hospital (n = 59) in a rural state who received in-person IDS treatment, with records from inpatients at nonmetropolitan, rural, and frontier hospitals (n = 48) in the same state who received telehealth IDS treatment. Outcome measures, including number of days hospitalized, number of days receiving intravenous antibiotic, survival, and transfer to another hospital, were compared for three commonly occurring infectious diseases: neutropenic fever, bacterial pneumonia, or bacterial wound infection. Patients treated via telehealth had fewer days on antibiotics and fewer days hospitalized than patients treated via in-person intervention. Survival rates did not differ significantly between groups, but were lower for telehealth patients. Fewer in-person patients required transfer to hospitals offering a higher level of care. Ninety percent of telehealth patients were able to remain at their local hospital for treatment. Results were statistically significant only for selected outcomes and conditions. IDS treatment for the conditions studied is equally effective when delivered via telehealth as when delivered via in-person methods.
authors.affiliation: Department of Mathematics and Statistics, South Dakota State University, Brookings, South Dakota, USA.
authors.forename: Aristides
authors.initials: A
authors.lastname: Assimacopoulos
authors.forename: Rabiul
authors.initials: R
authors.lastname: Alam
authors.forename: Manuel
authors.initials: M
authors.lastname: Arbo
authors.forename: Jawad
authors.initials: J
authors.lastname: Nazir
authors.forename: Ding-Geng
authors.initials: DG
authors.lastname: Chen
authors.forename: Susan
authors.initials: S
authors.lastname: Weaver
authors.forename: Marilyn
authors.initials: M
authors.lastname: Dahler-Penticoff
authors.forename: Karla
authors.initials: K
authors.lastname: Knobloch
authors.forename: Mary
authors.initials: M
authors.lastname: DeVany
authors.forename: Cheryl
authors.initials: C
authors.lastname: Ageton
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D003141:Communicable Diseases / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D005334:Fever / Q000188:drug therapy* / Q000209:etiology; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009503:Neutropenia / Q000150:complications; D009819:Office Visits / Q000191:economics / Q000706:statistics & numerical data; D005791:Patient Care / Q000379:methods; D018410:Pneumonia, Bacterial / Q000175:diagnosis / Q000188:drug therapy; D019114:Remote Consultation / Q000191:economics / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012424:Rural Population; D012680:Sensitivity and Specificity; D015996:Survival Rate; D017216:Telemedicine / Q000191:economics / Q000379:methods*; D016896:Treatment Outcome; D014946:Wound Infection / Q000188:drug therapy / Q000382:microbiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents